Healthcare Provider Details

I. General information

NPI: 1033093190
Provider Name (Legal Business Name): WOVEN PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HARVEY ST
CAMBRIDGE MA
02140-1752
US

IV. Provider business mailing address

350 REEDS BRIDGE RD
CONWAY MA
01341-9713
US

V. Phone/Fax

Practice location:
  • Phone: 617-480-4072
  • Fax:
Mailing address:
  • Phone: 617-480-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICA AGATE-MAYS
Title or Position: PRACTICE OWNER
Credential: LICSW
Phone: 617-480-4072